Hope and the Fight against HIV

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In February, Nobel laureate David Baltimore, president of the American Association for the Advancement of Science (AAAS), could scarcely have been more depressing. “We have been trying to make an HIV vaccine since the day HIV was discovered. In 1984 we were told that as the virus had been found, a vaccine should be just around the corner,” he reminded an audience at the annual AAAS meeting in Boston. “Every year since then, we have been saying it is at least 10 years away. I still think it is at least 10 years away.”

All attempts with vaccines to raise anti­bodies against HIV had failed, he observed. Researchers would need to go back to basics and pursue new approaches to fighting the virus. “Our lack of success may be understandable,” Baltimore declared, “but it is not acceptable.” It was (and remains) an admirable sentiment, but of course determination is no substitute for results for those in need.

A grim report in August from the Centers for Disease Control and Prevention drove home how numerous those in need are. The CDC concluded that it had been underestimating the number of new HIV infections in the U.S. by about 40 percent annually for the past 10 years or more. More than half of all new infections were in gay and bisexual men; African-Americans were seven times as likely to have contracted a new infection as whites, and Latinos were three times as likely. The catastrophe of HIV/AIDS in the developing world is even more horrifying.

If the past quarter of a century of vaccine research has been bleak, so has the outlook for a cure. Beyond killing certain immune cells outright, HIV can infiltrate and lie dormant in the central nervous system, the gut and other tissues, waiting for a chance to erupt and renew its assault on the body. So far the dream of curing HIV infections by eliminating the virus from the body remains elusive.

Even so, all is not lost. Our special report on the 25-year fight against HIV looks at both the vaccine and virus-elimination efforts, reviews where they failed and identifies the best opportunities for making some progress in the future.

Moreover, public hygiene–based prevention efforts and aggressive treatments of infections can still do much of what elusive vaccines and cures ever would, if society is prepared to commit to them. Safe-sex education and condom-distribution programs can help prevent not only HIV infections but also other sexually transmitted diseases. Meanwhile microbicides—creams and gels for killing vaginal infections that raise the risk of HIV transmission—show tremendous promise; they deserve far more research funding than they have received to date. Strong epidemiological evidence suggests that circumcision, too, reduces the risk of trans­mitting HIV as much as 60 percent.

For many HIV patients, protease inhibitors and other drugs have turned their infections into long-term manageable conditions. The treatment regimen called HAART (highly active antiretroviral therapy) can knock viral levels in the body down so low that transmission risk is greatly reduced. Scientists are even checking whether people at risk for infection might benefit from taking antiretroviral drugs before they are exposed.

Ideas for fighting HIV are not in short supply. But well-directed funding and commitment to clear-sighted public health policies sometimes are. We can’t blame the virus for that.

Note: This article was originally published with the title, "Hope and HIV".